Provider Demographics
NPI:1609820273
Name:KATHAIYAN, UDAYAKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:UDAYAKUMAR
Middle Name:
Last Name:KATHAIYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3381 PHILLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-1560
Mailing Address - Country:US
Mailing Address - Phone:843-477-0177
Mailing Address - Fax:843-232-2428
Practice Address - Street 1:3381 PHILLIS BLVD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-1560
Practice Address - Country:US
Practice Address - Phone:843-477-0177
Practice Address - Fax:843-232-2428
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053644A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200323590Medicaid
IN000000350967OtherANTHEM
IN000000350967OtherANTHEM
H23660Medicare UPIN